Healthcare Provider Details

I. General information

NPI: 1629469846
Provider Name (Legal Business Name): ALLYSSA PLYMELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 CLAY EDWARDS DR STE 625
NORTH KANSAS CITY MO
64116
US

IV. Provider business mailing address

2790 CLAY EDWARDS DR STE 625
NORTH KANSAS CITY MO
64116-3278
US

V. Phone/Fax

Practice location:
  • Phone: 816-455-3990
  • Fax: 816-455-5351
Mailing address:
  • Phone: 816-455-3990
  • Fax: 816-455-5351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015001256
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2011002137
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: